Health Policy Experts Sound Alarm: Key Changes to Medicaid You Need to Know

During a recent briefing, leaders from KFF shared concerns about how new laws affect vulnerable Americans. They believe that these changes add stress to individuals and the systems that support them.

One major point of contention is the federal work requirement for adults in states that expanded Medicaid. Robin Rudowitz, who oversees KFF’s Medicaid program, noted that many people with mental health issues or substance use disorders gained access to care through this expansion. However, since they don’t qualify as disabled, they must now adhere to the new work rules. While there are exemptions, it’s likely that states won’t have up-to-date information on individuals’ conditions. This can be especially tough for people during their first episode of psychosis, as they may not have a Medicaid claim history to prove their situation.

Hospitals might try to help their patients maintain coverage by submitting necessary documentation. Still, Rudowitz mentioned that the overall process remains unclear, leading to potential gaps in coverage. This uncertainty disproportionately affects rural hospitals, which are already facing tough times. Larry Levitt from KFF highlighted that hospital closures are increasing for various reasons. These new laws might make financial struggles even worse, especially since states rely on provider taxes to help fund Medicaid.

Another pressing concern is the expiration of enhanced Affordable Care Act subsidies at the end of 2025. Cynthia Cox pointed out that around 22 million people will see a spike in their premiums starting January 1, 2026. Many might switch to cheaper plans or pay more out of pocket, but Cox warned that it could result in 4 million more uninsured Americans. Those just above the poverty line in states that didn’t expand Medicaid will face significant hardships, going from paying nothing to around 2% of their income.

Higher-income enrollees, like small business owners, will also feel the impact. They could go from paying about 8.5% of their income on premiums to the full sticker price, making healthcare less affordable overall. Drew Altman, KFF’s president, emphasized that it’s not just the number of uninsured that matters; rising healthcare costs affect many people’s financial stability.

There are also implications for lawfully present immigrants. Drishti Pillai, who leads KFF’s immigrant health policy program, noted that 14 states and D.C. currently use their own funds to assist some immigrant groups. With states facing higher costs, these programs might face cuts. The ACA’s coverage for immigrants is at risk as well, increasing demand on state-funded safety nets.

People with disabilities could be impacted, too. Many individuals may not meet formal disability criteria but still have disabling conditions. They may be required to meet work requirements without the protections others have. Tricia Neuman, KFF’s Medicare policy lead, warned that budget pressures could lead to cuts in essential benefits such as home care and transportation services.

The elderly are also feeling the strain. Six in ten nursing home residents are on Medicaid, and Rudowitz expressed concern that blocking new staffing rules could worsen shortages and jeopardize care quality. Additionally, budget cuts in food assistance programs like SNAP could negatively impact the nutritional support older adults rely on.

There’s talk that some states may quickly implement Medicaid work requirements before the 2027 deadline. Rudowitz cautioned that once the law is in place, it will be challenging to adjust policies across states due to strict regulations on waivers.

Overall, the combination of rising costs, stricter requirements, and potential service cuts could create significant challenges for many Americans in the coming years. This situation highlights the importance of clear communication and responsible policymaking to better serve vulnerable populations.



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Medicaid,Medicaid cuts,KFF